Thoracic Disc Research Articles

Thoracic Discectomy Through a Unilateral Transpedicular or Costotransversectomy Approach With Intraoperative Ultrasound Guidance.

The disc location, extent of calcification, limited visualization of the ventral cord, and tenuous blood supply to the thoracic spinal cord pose unique technical challenges when surgically treating thoracic disc herniation. To report our initial experience with a series of cases in which intraoperative ultrasound image guidance was used for thoracic discectomy through a unilateral transpedicular or costotransversectomy approach. Five patients (n=5) underwent a transpedicular approach and five (n=5) underwent costotransversectomy for thoracic discectomy. Pre- and postoperative clinical records, operative reports, disc location/calcification, and complications were reviewed. There were 6 (n=6) males and 4 (n=4) females with an average age of 54 yr (range: 33-74). All patients had symptoms attributable to a single-level of thoracic disc herniation. Discs were classified as central (n=5) and paracentral (n=5). Preoperative CT and/or intraoperative visualization demonstrated calcified disc material in 6 (n=6) patients. Final outcomes data at last follow-up was available for 9 of 10 patients. Eight of these nine patients experienced a return to normal baseline functional status. Postoperative imaging confirmed that no wrong-level surgeries were performed. The mean length of follow-up was 20.4 wk (range 4-48). Thoracic discectomy with ultrasound visualization via a unilateral transpedicular or costotransversectomy approach is safe and effective for treatment of central and paracentral calcified disc herniations. This tool improves the safety profile of thoracic discectomy and allows for treatment of thoracic discs through less invasive approaches.

Transforaminal Thoracic Interbody Fusion for Thoracic Disc Prolapse: Surgicoradiological Analysis of 18 Cases.

Study Design:Retrospective observational study.Objectives:Thoracic disc prolapse (TDP) surgeries have reported complications ranging from paraplegia to approach related complications. This study is to present a series of TDP patients surgically treated with transforaminal thoracic interbody fusion (TTIF). Emphasis on surgical technique and strategies to avoid complications are analyzed.Methods:Eighteen patients with TDP were included. Imagings were analyzed for end-plate changes and calcification. Type of disc prolapse (central/para-central) and percentage of canal occupancy were noted. Objective outcome was quantified with Visual Analogue Scale (VAS), modified Nurick’s grade, and ASIA (American Spinal Injury Association) score. All complications were noted.Results:Eighteen patients (average age 43.65 years) having total 22 levels operated, that included double level (n = 2) and missed level (n = 2) are reported. All patients had myelopathy. Calcification of disc (n = 13), central disc prolapses (n = 9), para-central (n = 11) and more than 50% canal occupancy (n = 8) were noted. VAS back pain, modified Nurick’s grade and ASIA grade improved significantly in all patients. One patient had postoperative transient deficit. The functional score achieved its maximum at 1 year follow-up and remained static at final follow-up of 65.05 months. Union was achieved in all patients.Conclusions:The most important factor for outcome in TDP is the technical aspect of avoiding cord manhandling and avoiding wrong level surgeries. TTIF is not devoid of complications but can give good results to posterior approach trained surgeons.

Primary spinal epidural diffuse large B-cell lymphoma with paraplegia as the first manifestation: a case report.

Primary spinal epidural diffuse large B-cell lymphoma (DLBCL) is rare and often easily misdiagnose. Here, we presented a case of primary spinal epidural DLBCL with paraplegia as the first manifestation. He was misdiagnosed as thoracic disc herniation and thoracic tuberculosis successively. DLBCL was confirmed after surgery ultimately. After 6 cycles of chemotherapy with R-CHOPE, the patient went back to normal life without relapse during 2-year follow-up. Primary spinal epidural lymphoma should be suspected in patients with spinal cord compression with imaging showing isointense, homogeneous extradural contiguous level compressive soft‑tissue lesion without bony involvement and previous history of cancer.

Removal of the intervertebral thoracic disc hernia under intraoperative neuromonitoring: case series

Objective. To analyze the results of the removal of thoracic intervertebral disc hernia through posterior surgical approach using intraoperative neuromonitoring.Material and Methods. A total of 14 patients aged 43–64 years (M = 53.9) were operated on through posterior approach for symptomatic hernia of the thoracic intervertebral discs, with myelopathy (isolated or in combination with radiculopathy) in seven cases, and with isolated radiculopathy in another seven cases. Hernia were ossified in 6 cases. Operations were performed using intraoperative neuromonitoring. In 11 cases, unilateral or bilateral laminectomy and facetectomy were performed to remove a hernia; in three cases – laminectomy with resection of the facet joints and pedicles (in two of them, with ossified large and giant hernias, radiculotomy was performed to mobilize the dural sac).Results. The long-term clinical results of surgical interventions were evaluated 1–4 years after the surgery using VAS-10, ODI, and Frankel scales. VAS scores decreased by 2–6 points In 11 patients, and remained at the same low level characterized by mild pain (1–2 points) in three patients. In patients with myelopathy, the Frankel scale showed a positive trend in six out of seven cases. Two patients showed an increase in neurological deficit in the postoperative period. In one case, neurological disorders regressed within a short period of time, in the other one, they became permanent. Damage to the dura mater was observed in two cases.Conclusion. Intraoperative neuromonitoring allows the surgeon to act more actively and confidently in the area of disco-medullar conflict and thereby avoid excessive expansion of surgical approach without compromising the surgical result. A small number of observations does not allow making evidence-based conclusion.

Intradural non-calcified thoracic disc herniation causing spontaneous intracranial hypotension: a case report

BackgroundSpontaneous intracranial hypotension (SIH) is a rare pathology caused by a cerebrospinal fluid (CSF) leak. If intractable by conventional methods (i.e. bedrest, analgesics, or epidural blood patching) it may lead to the inability of the patient to cope with daily life and eventually to life-threatening complications. Recently, calcified discogenic microspurs or dorsal osteophytes were identified as a major cause for ventral CSF loss through vertical longitudinal dural slits. We report a rare case of intractable SIH due to an intradural disc herniation at the thoracolumbar junction (without signs of calcification) and its management.Case presentationA 46-year old woman suffered from orthostatic headache (sudden onset, no history of trauma) due to intractable SIH for over 2 month (without neurologic deficits). There was no clinical amelioration by conservative measures (analgesics, bedrest) and serial unspecific epidural blood patches (repeated for 3 times). She was diagnosed with an intradural disc herniation at the thoracolumbar junction causing a CSF leak. Surgical exploration by a translaminar and transdural approach with removal of the disc herniation and closure of the CSF leak was performed with immediate cessation of orthostatic symptoms. Histological workup revealed non-calcified intervertebral disc material. After 3 months of follow-up and no evidence for clinical relapse the patient returned to work.ConclusionsWe report the rare phenomenon of an intradural non-calcified disc sequester at the thoracolumbar junction as the cause of a ventral dural tear leading to a CSF leak with intractable SIH. This is of particular interest as the major cause of ventral dural leakage is thought to arise from calcified discogenic microspurs or dorsal osteophytes. Furthermore, we comprehensively describe a short and reasonable diagnostic and surgical approach of this rare pathology, which may particularly be of use in daily clinical routine in neurological wards and general surgical spine centers not facing such pathologies on a regular basis.

Bone cylinder plug and coil technique for accurate pedicle localization in thoracic spine surgery: A technical note.

Background:Intraoperative identification of the correct level during thoracic spine surgery is essential to avoid wrong-level procedures. Despite technological progress, intraoperative imaging modalities for identifying the correct thoracic spine level remain unreliable and often lead to wrong-level surgery. To counter potential wrong-level operations, here, we have proposed a novel pedicle/bone cylinder marking technique for use in the thoracic spine utilizing biplanar fluoroscopy and confirmed with computed tomography (CT).Methods:First, under fluoroscopic guidance, a bone cylinder is removed from the correct thoracic pedicle. Next, endovascular coils are packed into the cancellous bone defect followed by reinsertion of the bony plug. The patient then undergoes a CT scan of the entire thoracolumbosacral spine to precisely identify the marked level before surgery.Results:We utilized this bone cylinder plug/coil technique to identify the T9-T10 level in a 56-year-old female with a soft thoracic disc herniation. The index thoracic pedicle was successfully localized before performing the unilateral minimally invasive laminectomy followed by the transpedicular thoracic disc excision.Conclusion:The bone cylinder plug/coil technique is a safe and effective method for marking the correct level in thoracic spine surgery, while also reducing the operative time.

Transforaminal Posterior Approach Is Effective for Treatment of Lower Thoracic Spine Spondylodiscitis.

Patients with lower-thoracic spine pathologies that affect anterior column stability and compress the neural tissues need anterior decompression and reconstruction. Anterior approaches result in long-term morbidities. Posterior laminectomy and fixation alone may not be sufficient to maintain spine stability. To evaluate the results of a posterior-only transforaminal thoracic interbody fusion approach for patients with thoracic disc space infection in terms of the improvement in neurologic status, resolution of infection, correction of kyphotic deformity, and assessment of post-operative complications. A prospective study was done on 40 patients with lower thoracic spine spondylodiscitis. All patients were assessed with pre-operative imaging. Neurologic assessment was performed using the American Spinal Injury Association (ASIA) Impairment Scale and functionally by the modified Japanese Orthopedic Association (JOA) scale. Pre-operative and post-operative white blood cell count, erythrocyte sedimentation rate, and C-reactive protein levels were compared. All patients were operated on through a posterior approach using the transforaminal thoracic interbody fusion for decompression, reconstruction, and anterior fusion. Mean age of patients was 49years; mean operative period was 188min; mean blood loss was 611mL. Twelve patients' ASIA scores improved and only two patients' scores declined. One patient died 11months post-operatively due to septicemia. The mean follow-up period was 27.8months. The modified JOA score improved from 6.3 ± 1.6 to 9.5 ± 0.6. The local kyphosis angle was improved from 13.8 to 6.9° post-operatively, with insignificant loss of correction at the end of follow-up. Thirty-eight out of 40 patients had solid anterior fusion at the end of follow-up. The clinical outcomes of this study showed that the transforaminal thoracic interbody approach is effective for both decompression and anterior reconstruction of the lower thoracic spine in patients with spondylodiscitis.

In vivo contrast-enhanced microCT for the monitoring of mouse thoracic, lumbar, and coccygeal intervertebral discs.

Mouse models are often used for studies of intervertebral disc (IVD) homeostasis and degeneration, yet the relatively small size of the IVD poses challenges for noninvasive, longitudinal imaging modalities. The recently developed contrast‐enhanced microCT (CEμCT) using Ioversol has been successful in detecting degenerative changes in the murine IVD ex vivo at the micrometer scale. Further leveraging the superior biocompatibility of Ioversol as a contrast agent, we demonstrate the in vivo use of this CEμCT technique to examine IVDs at multiple spinal sites. Ioversol was administered via tail vein injection (TVI) in growing and adult male FVB/NJ mice (n = 5 /group). The animals were anesthetized and underwent in vivo micro‐computed tomographic (microCT) at the coccygeal (CC5/CC6), lumbar (L5/6), and thoracic (T12/T13) IVDs. TVI of Ioversol was well‐tolerated by all animals. As Ioversol filtered through the kidneys and accumulated in the bladder, the attenuations of the mouse bladder and kidneys increased due to the high molecular weight of Ioversol, confirming that the Ioversol is biological available. Average IVD attenuations increased 3%‐15% following TVI (ANOVA; P < .01). The presence of Ioversol in the IVD combined with high‐resolution microCT allow for nondestructive visualization of structural features of the IVD. These results demonstrate CEμCT with Ioversol as a viable strategy for the in vivo monitoring of multiple mouse IVDs during degeneration, disease, and injury.

Management of Giant Thoracic Disc Herniation by Thoracoscopic Approach: Experience of 53 Cases.

Giant thoracic disc herniation (gTDH) is a rare condition. It is defined by a herniation that occupies at least 40% of the thoracic spinal canal and is usually calcified. Several surgical techniques have been described to date but this surgery remains a technically difficult procedure. To report the long-term outcome of 53 patients with myelopathy due to gTDH who were operated on by a thoracoscopic approach. The technical details of the preoperative assessment and the surgical procedure are presented. We present a retrospective study of a database of 53 patients operated for symptomatic gTDH by a thoracoscopic approach. The following clinical parameters were assessed initially and used during follow-up: Frankel grade and JOA score adapted to the thoracic spine (mJOA), pain in the lower limbs and limitation of the walking perimeter to less than 500 meters. The quality of spinal cord decompression was assessed postoperatively by magnet resonance imaging (MRI). The mean follow-up was 78.1 mo (SD 49.4). At the last follow-up visit, clinical examination showed a mean improvement of 0.91 Frankel grade (P<0.001) and 2.56 mJOA score respectively (P<0.001). Lower limb pain and walking perimeter were also improved. Postoperative MRI revealed that the resection was complete in 35 cases, subtotal in 13 cases, and incomplete in 5 cases. gTDH is a condition that often evolves favorably after surgery. The thoracoscopic approach is a feasible alternative technique.

Thoracic spine disc degeneration, translation, and angular motion: An analysis using thoracic spine kinematic MRI (kMRI)

The aim of this study was to evaluate disc degeneration and kinematic changes in translation and angular motion of the thoracic spine using kinematic MRI (kMRI). 105 thoracic spine kMRI were analyzed from T4-5 to T11-12 using MRAnalyzer3. Translational and angular motion were evaluated in neutral, flexion, and extension positions. Thoracic disc height and disc degeneration grading were measured in the neutral position. Intraclass Correlation Coefficients were used to analyze agreement among three observers. The Friedman’s test was used to analyze the difference in disc height, disc degeneration, translational motion, and angular motion. The Wilcoxon-signed rank test was used for post-hoc analysis with a Bonferroni correction. A p-value of 0.00625 was used to establish a statistically significant difference. Analysis using the Friedman’s test revealed that translational motion, disc height, and disc degeneration were significantly different from T4-5 to T11-12 (p < 0.001). The T4-5 level showed the least translational motion, while the T10-11 showed the most translational motion. The lower thoracic level (T8-12) showed significantly more translational motion, more advanced disc degeneration, and greater disc height than the upper thoracic level (T4-8, p < 0.001). T11-12 showed the most advanced disc degeneration. There was a significant negative correlation between disc degeneration and translational motion at the upper thoracic level (p = 0.013). The lower thoracic region (below T8) had significantly more translational motion, more advanced disc degeneration, and greater disc height. This information is crucial in further understanding thoracic spinal kinematics and may contribute to determining the stopping level in fusion surgeries involving the thoracic spine.

Twente Spine Model: A thorough investigation of the spinal loads in a complete and coherent musculoskeletal model of the human spine

Although in vivospinal loads have been previously measured, existing data are limited to certain lumbar and thoracic levels. A detailed investigation of spinal loads would assist with injury prevention and implant design but is unavailable. In this study, we developed a complete and coherent musculoskeletal model of the entire human spine and studied the intervertebral disc compression forces for physiological movements on three anatomical planes. This model incorporates the individual vertebrae at the cervical, thoracic, and lumbar regions, a flexible ribcage, and complete muscle anatomy. Intradiscal pressures were estimated from predicted compressive forces, and these were generally in close agreement with previously measured data. We found that compressive forces at the trunk discs increased during trunk lateral bending and axial rotation of the trunk. During flexion, compressive forces increased in the thoracolumbar and lumbar regions and slightly decreased at the middle thoracic discs. In extension, the forces generally decreased at the thoracolumbar and lumbar discs whereas they slightly increased at the upper and middle thoracic discs. Furthermore, similar to a previous biomechanical model of the cervical spine, our model predicted increased compression forces in neck flexion, lateral bending, and axial rotation, and decreased forces in neck extension.

A Review of Minimally Invasive Surgical Techniques for the Management of Thoracic Disc Herniations.

Thoracic disc herniation (TDH) is a rare, but technically challenging, disorder. Apart from their unfamiliarity with this condition, surgeons are often posed with challenges regarding the diverse methods available to address TDH, the neurological disturbances accompanying the disorder, the prospect of iatrogenic cord damage during surgical procedures, and the complications associated with various surgical approaches. In today’s era, when minimally invasive surgery has been incorporated into almost every aspect of managing spine disorders, it is necessary for surgeons to be aware of the various minimally invasive techniques available for the management of these rare and difficult conditions. In this review article, we provide a synopsis of the epidemiology, clinical features, and technical aspects of TDH, starting from level identification to intraoperative neuromonitoring and including important steps and guidance for all the minimally invasive approaches to TDH. We conclude the review by providing insights into the clinical decision-making process and outline the specific aspects of “giant” thoracic discs and indications for fusion in certain conditions. Outcomes of minimally invasive surgery for these conditions are generally favorable. The location of herniation is an important factor for surgical planning.

Effectiveness of Percutaneous Intradiscal Decompression Therapy in Thoracic Disc Herniation

Aims:Although there have been many studies about lumbar and cervical ablation procedures, few studies have been performed in the thoracic region. To evaluate the clinical results of a percutaneous disc decompression device in patients with radicular symptoms and/or dorsal pain due to thoracic disc herniation.Methods:Eleven patients with thoracic disc herniation and/or degenerative discs (all in T10-T11, or T11-T12 levels) who did not respond to conservative treatments were undergoing ablation and compression procedures. Pain and radicular symptoms consistent with the thoracolumbar region were confirmed via abnormal magnetic resonance imaging findings after detailed anamnesis and physical examination. All patients were evaluated before and 1, 3, 6, and 12 months after treatment using the visual analog scale score. The patient satisfaction scale was used to evaluate the level of patient satisfaction at the end of the treatment at 12 months.Results:The median visual analog scale score was 7.00±0.45 points before treatment and 2.73±0.65 points at 12 months post-procedure and were statistically significant (p<0.001). The results of pairwise comparisons using the Bonferroni Corrected Wilcoxon Signed-Rank test showed that there were statistically significant differences. The mean visual analog scale score at the beginning (7.00±0.45) was significantly higher than the mean score of other months. Postoperative improvement was significant with a 99% confidence interval. No complications that may cause permanent damage occurred.Conclusion:Percutaneous disc decompression is an effective and safe procedure to treat pain caused by lower thoracic intervertebral disc disease, which did not respond to conservative treatments.

Microsurgical Experience with Pedicle-Sparing Transfacet Approach for Thoracic Disk Herniation.

Thoracic disk herniation (TDH) is relatively uncommon. The surgical approach differs from lumbar or cervical disk herniations because serious complications are associated with the posterior approach in TDH. Various different approaches have been tried for the surgical removal of TDH, but most of them are cumbersome surgeries such as thoracotomy or thoracoscopic or anterior approaches with or without instrumentation. The requirement for a simplified, familiar, and less morbid surgery has motivated some new approaches. A pedicle-sparing transfacet approach (PSTA) was first described in 1995, but to date no sufficient clinical series has been presented in the literature to report on its feasibility and applicability along with complication and morbidity rates. Our objective was to assess the feasibility of the PSTA under microscopic visualization in a cumulative clinical series. Twenty-eight consecutive patients with no response to medical/physical treatment with and without motor weakness of their lower extremities underwent the surgery for TDH via the PSTA under microscopic visualization by a senior neurosurgeon. Preoperative and postoperative low extremity muscle strength, sensation, reflex status, and visual analog scores (VAS), Nurick grades, and complications were recorded. Postoperative MRI within 24 hours was performed. The median follow-up period was 33 months. The patients consisted of 16 men and 12 women. The disk levels ranged from T8 to T12-L1. All but one patient received one-level surgery. One patient was operated on two levels. A total of 21 patients had paracentral disk herniations; the other 7 had central disk herniations. Postoperative MRI showed satisfactory removal of disk herniation in all but one patient. There was no infection, wrong level surgery, or incidental durotomy. Median VAS levels significantly improved after the operation from 7.4 to 2.3. The Nuric grades decreased from 2.7 to 1.6 after surgery. The microsurgical PSTA is a safe and feasible technique with a significantly shorter surgeon's learning curve. The approach offers a wide surgical window; moreover, it can by increased by tilting the surgical table allowing satisfactory decompression of TDH. After PSTA, segmental instrumentation is not required.

Thoracic disc herniation, avoidance, and management of the surgical complications.

Thoracic disc herniations are a relatively rare occurrence compared to disc herniations in the cervical or lumbar spine. Surgical management of these thoracic herniations can be technically difficult with a wide array of reported complications. In this study, we aim to describe the most common complications that can occur during or after surgical management of thoracic disc herniations. Furthermore, we describe tips and tricks for avoidance and, if necessary, management of surgical complications. Common complications addressed in this review include vertebral column instability, neurologic injury, cerebrospinal fluid leak/pleural fistula, thoracic viscera injury, wrong level surgery, incomplete disk resection, and intercostal neuralgia.

Percutaneous endoscopic decompression for calcified thoracic disc herniation using a novel T rigid bendable burr

Background The basic endoscopic instruments are not suitable for removing calcified or hard discs in patients with thoracic disc herniations (TDH). We describe a percutaneous endoscopic technique for the treatment of calcified TDH using an endoscopic drill system with a T rigid bendable burr. Methods Eleven patients (8 males, mean age 42.1 years) with single-segmental calcified TDH were treated with percutaneous endoscopic surgeries. Results Our technique using this endoscopic drill system with a T rigid bendable burr is safe and effective for the treatment of calcified TDH. Conclusions Percutaneous endoscopic decompression using the T rigid bendable burr is a safe and reproducible surgical procedure for the treatment of calcified TDH.

Clinical outcomes of symptomatic thoracic disk herniations treated surgically through minimally invasive lateral transthoracic approach.

Although symptomatic thoracic disk herniation (TDH) is relatively rare, its treatment is quite difficult. Our aim is to present the outcomes and complications in patients with thoracic disk herniation treated with minimally invasive lateral transthoracic approach (LTTA). Fifty-nine consecutive patients with 69 symptomatic disk herniations that underwent minimally invasive LTTA to treat TDH between 2007 and 2016 were enrolled. Medical records were reviewed retrospectively. The numbers of TDH were as follows: 41 central, 10 paracentral, and 18 both central and paracentral. The number of calcified disk herniations was found to be 32. No patient developed neurological deficit. Postoperative neurological improvement occurred in 39 (90.7%) of 43 patients with myelopathy. Preoperative VAS scores, ODI scores, and SF-36 scores improved at the follow-up, respectively. Mean blood loss, hospitalization period, and follow-up period were found to be 391.2mL, 4.7days, and 60months; respectively. The following complications were observed: dural tear (five patients), intercostal neuralgia (three patients), rib fracture (one patient), pleural effusion requiring chest tube (two patients), hydropneumothorax requiring chest tube (one patient), small pneumothorax (one patient), atelectasis (one patient), pulmonary embolism (one patient), and pneumonia (one patient). Minimally invasive LTTA not only minimizes the manipulation of the thecal sac decreasing the risk for neurological injury compared to traditional posterior methods but also significantly decreases the pulmonary complications associated with traditional open procedures. Based on the authors' experience, anterior approach should be preferred especially in calcified central disk herniations regardless of surgeon's experience.

Unilateral foot drop caused by thoracic herniated intervertebral disc

Introduction: Among the spinal disorder, unilateral weakness of foot dorsiflexion (drop foot) usually arises from lumbar herniated intervertebral discs (HIVD), especially at the L4/5 level. In contrast, symptomatic thoracic HIVD is rare, and the most common symptoms are pain and sensory disturbance along the involved root dermatomes. Myelopathy below the affected spinal level has been reported with central and large thoracic disc herniation.

Anterolateral Approach for Central Thoracic Disc Prolapse-Surgical Strategies Used to Tackle Differing Operative Findings: 3-Dimensional Operative Video.

Thoracic disc prolapses causing cord compression can be challenging. For compressive central disc protrusions, a posterior approach is not suitable due to an unacceptable level of cord manipulation. An anterolateral transthoracic approach provides direct access to the disc prolapse allowing for decompression without disturbing the spinal cord. In this video, we describe 2 cases of thoracic myelopathy from a compressive central thoracic disc prolapse. In both cases, informed consent was obtained. Despite similar radiological appearances of heavy calcification, intraoperatively significant differences can be encountered. We demonstrate different surgical strategies depending on the consistency of the disc and the adherence to the thecal sac. With adequate exposure and detachment from adjacent vertebral bodies, soft discs can be, in most instances, separated from the theca with minimal cord manipulation. On the other hand, largely calcified discs often present a significantly greater challenge and require thinning the disc capsule before removal. In cases with significant adherence to dura, in order to prevent cord injury or cerebrospinal fluid leak a thinned shell can be left, providing total detachment from adjacent vertebrae can be achieved. Postoperatively, the first patient, with a significantly calcified disc, developed a transient left leg weakness which recovered by 3-month follow-up. This video outlines the anatomical considerations and operative steps for a transthoracic approach to a central disc prolapse, whilst demonstrating that computed tomography appearances are not always indicative of potential operative difficulties.

Surgical Management of Thoracic Disc Herniation: Anterior vs Posterior Approach.

To compare outcomes and complications in patients with thoracic disc herniation (TDH) undergoing surgery with either the posterior or anterior approach. A total of 86 patients, with 98 symptomatic TDHs, who underwent surgery in a single institution between 2007 and 2016, were included. Overall, 68 patients were in the anterior and 18 were in the posterior group. Ten patients underwent multilevel TDH surgery. The groups were similar in age, sex, body mass index, and clinical symptoms. In the anterior group, 4 patients (5.9%) had major complications, and 26 (38.2%) had minor complications. In the posterior group, 6 patients (33.3%) had major complications, and 4 (22.2%) had minor complications. Visual analog scores at the final follow-up improved in both groups as compared to baseline preoperative scores (p > 0.05). The rate of neurological improvement in patients with myelopathy was significantly higher in the anterior group (43/50) than in the posterior group (8/14) (p < 0.05). The current study showed that higher rates of major complications in central and calcified paracentral TDHs are associated with posterior approaches when compared to anterior approaches. In addition, anterior approaches had superior neurological recovery and clinical outcomes. Therefore, we recommend the anterior approach for the treatment of calcified and/or non-calcified central and calcified paracentral TDH, while reserving posterior approaches for small non-calcified paracentral disc herniations.